Demographic differences in complication and failure to rescue rates following lung transplantation.

Background: We evaluated the association between race/ethnicity and failure to rescue (FTR) following lung transplantation. Methods: We conducted a retrospective cohort study of 34,184 patients undergoing primary lung transplantation (2006-2024). Race/ethnicity was categorized as non-Hispanic White (81.3%), non-Hispanic Black (9.5%), and Hispanic (9.1%). The primary outcome was FTR. Logistic regression identified predictors of FTR, while Cox proportional hazards models assessed the association between race/ethnicity and outcomes. Results: Black patients experienced the highest rates of postoperative complications (26.3%) compared to non-Hispanic White (17.9%) and Hispanic patients (19.6%) (p < 0.001). Mortality rate was also highest among Black patients (6.8%) compared to White (5.0%) and Hispanic patients (4.8%) (p <0.001). However, race/ethnicity was not independently associated with FTR. Risk factors for FTR included dialysis at transplant (OR 2.05, 95% CI: 1.28-3.29, p=0.003), double lung transplant (OR 1.30, 95% CI: 1.09-1.56, p=0.004), and prolonged ischemic time (OR 1.05, 95% CI: 1.02-1.08, p=0.001). Conclusions: While Black patients experienced higher complication and mortality rates, race/ethnicity was not independently linked to FTR after lung transplantation.